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The Dawn of Medicine
ancient Egypt and Athotis,
the king-physician
Jakub Kwiecinski
ABSTRACT The earliest physician recorded in history is Athotis (Aha), one of the
first rulers of ancient Egypt. While it is debatable whether the story of a king-physician is a fact or just a legend, it is clear that ancient Egyptian medicine developed
around the time of his reign. The fortunate combination of earlier medical observations, the development of script, and favorable social conditions made the dawn of ancient Egypt also the dawn of medicine.
the medical profession, one instinctively
looks at its history. Questions come to mind, such as when did it start,
and who was the first physician? A practice of healing seems to be as old as the
mankind (Majno 1975), so it is unlikely that one will ever find the exact answers.
However, when searching for the first known physician, we come to ancient
Egypt and one of Egypt’s first rulers, Athothis.
In a third-century BCE history of Egypt, written by an Egyptian priest,
Manetho (1940), there is a passage about a ruler of the First Dynasty: “Athothis
. . . built the palace at Memphis, and his anatomical works are extant, for he was
a physician” (or, in another preserved version,“he practised medicine and wrote
anatomical books”). Is it possible that the earliest known physician was indeed
W
HEN TRYING TO UNDERSTAND
Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of
Gothenburg, Box 480, 405-30, Gothenburg, Sweden.
E-mail: [email protected].
The author thanks Krzysztof M. Ciałowicz (Institute of Archeology, Jagiellonian University, Poland)
for valuable comments on the manuscript, and his father, Andrzej Kwiecinski, for showing him how
exciting history is.
Perspectives in Biology and Medicine, volume 56, number 1 (winter 2013):99–104
© 2013 by The Johns Hopkins University Press
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an Egyptian ruler? What was the source of his knowledge? Did he write the first
medical book? Some researchers find it “very hard to believe,” “doubtful,” or
suggest that Manetho was confused (Estes 1989; Jonckheere 1952; Nunn 1996).
Others, to the contrary, think that it is possible and call Athothis an “enthusiastic amateur” (Ghalioungui 1983; Gordon and Schwabe 2004). To resolve this
contradiction, one should first look at the time in which Athothis lived and
reigned: the dawn of Egypt’s history.
Formation of the Egyptian State
Initially, several cultural groups inhabited the area along the Nile. As the culture
from the south was spreading northwards, a gradual integration occurred.
Around 3200 BCE, all of Egypt became culturally united (Bard 2003; Ciałowicz
2001; all dates according to Bard).This was followed by a political consolidation,
probably through a mixture of alliances and warfare. Between 3200 and 3000
BCE, one united Egypt emerged, reigned by kings of the so-called “Dynasty 0”
(Bard 2003). Around 3000 BCE, a ruler named Narmer laid a final base for the
state by creating an efficient public administration, strengthening trade contacts
with neighboring countries, initiating construction projects, and increasing the
young nation’s wealth (Ciałowicz 2001). Narmer was later remembered as the
creator of the Egyptian state and the founder of the First Dynasty.
Narmer was followed by Aha, the second ruler of the First Dynasty, identified
nowadays as Athothis from Manetho’s story (Cervelló-Autuori 2003; Ciałowicz
2001). According to different sources, Aha ruled for 27 to 57 years, and during
his reign he continued foreign trade and secured Egypt’s western and southern
borders. He may have expanded the borders by force, in accordance with his
name, translated as “Warrior.” Aha also carried on developing Memphis, a city
later to become the capital, and erected new temples and fortifications (Ciałowicz 2001). Finally—if one believes Manetho—he was a practicing physician.
Origins of Egyptian Medicine
Although serious study of medicine around 3000 BCE may seem incredible, evidence suggests that it happened in Egypt as early as the period of the state’s formation. Hieroglyphs depicting internal organs were already in use during the
First Dynasty (Figure 1). Moreover, those early depictions were sometimes anatomically more accurate then later “conventional” versions of hieroglyphs (Godron 1956; Kwiecinski 2012). From predynastic times come also the first traces of
disease treatments. Skinned mice were found in children’s stomachs, probably
used (without success) as the last remedy to delay their death (Dawson 1924).An
ancient patient with ankylosing spondylitis consumed honey (or propolis) during
his last days, probably as a medication (Emery-Barbier 2008). Also, red ochre and
green and black ores were used for cosmetic and medical purposes already at the
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Figure 1
Alabaster bowl with Aha’s name: a falcon holding a mace and a shield, inscribed seated on top
of a stylized palace’s façade (signifying a royal name).The first hieroglyph from the left is
an early depiction of a heart, with six blood vessels leaving it in three directions.
S OURCE: R EPRODUCED
AFTER
K APLONY (1964), WITH PERMISSION FROM
H ARRASSOWITZ P UBLISHING H OUSE .
predynastic period (Baduel 2008; Emery-Barbier 2008). Notably, mice, honey, and
pigments became a part of the classical Egyptian pharmacopoeia.
Accurate anatomical depictions and first attempts of therapy are a testimony
to the Egyptians’ interest in medicine at that early date. In the emerging Egyptian state, some activities or disciplines that we nowadays see as separate—governing, religion, healing, and animal husbandry—were probably closely linked
(Gordon and Schwabe 2004). One can easily imagine that the elites of the society—participating in animal sacrifices, taking care of sacred animals, and supervising livestock—had a perfect opportunity to make anatomical and physiological observations and to develop healing methods for both animals and humans.
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Such knowledge would probably be further supplemented with experiences
from treating wounded people (Nunn 1996).The plausibility of this scenario is
confirmed by the example of the modern Dinka people, who possess a reasonable medical knowledge, derived mainly from their experience with cow and
goat husbandry and observations of internal anatomy during animal sacrifices
(Schwabe and Kuojok 1981).
The earliest proof of the existence of Egyptian medical literature comes from
the first half of the 25th century BCE, in a tomb inscription recounting a story
of vizier Weshptah’s death. When he had fallen unconscious during a royal inspection of a construction site, the king ordered the senseless vizier conveyed to
a court.There “his majesty had the royal children, companions, ritual priests, and
chief physicians come. . . . His majesty [had] brought for him a case of writings”
(Breasted 1906). Unfortunately, despite the use of medical books, the case was
hopeless.
At the time of Weshptah’s accident, it was apparently a standard practice to
consult medical literature. Is it possible that such writings appeared 500 years
earlier, during Aha’s reign? Indirect evidence suggests that the early state kept
some kind of economic records and historical annals (Bard 2003; Ciałowicz
2001), so it is not unreasonable to conclude that the art of writing was advanced
enough at that time to allow the creation of the first short medical notes.
Aha, a King-Physician?
No text authored by Aha survives to our times. Some researchers initially
thought that he was mentioned in one of the preserved medical papyri, but it
turned out to be a misunderstanding (Yoyotte 1958). Nevertheless, an anatomical treatise attributed to him must have existed at the time of Manetho. While
the practice of falsely claiming the ancient authorship of texts was not uncommon in Egypt, and distinguished historical figures frequently had wisdom texts
ascribed to them centuries later, it is surprising that a medical writing would be
ascribed to a king, as medical prescriptions were usually attributed to gods and
famous priests or physicians (Ghalioungui 1973; Kemp 2006; Nunn 1996).This
exception to the general rule proves a strong association of Aha with medicine
in ancient Egyptians’ minds.
We know nothing about the everyday life of a royal court and the upbringing of an heir to the kingdom during the First Dynasty.Was there any time and
opportunity for a medical training? It is hard to believe that any king would have
been a physician engaged in anatomical studies (Nunn 1996). However, there are
examples of royal relatives and influential local rulers practicing medicine. For
example, Mereruka, vizier and son-in-law to king Teti, was an overseer of the
palace physicians, and Neheri, a provincial governor, prepared medicines for the
sick (Ghalioungui 1983; Nunn 1996). Such situations may have been even more
plausible during the state formation, when rulers were probably personally
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involved in animal sacrifices and husbandry, thus having an opportunity to observe anatomy and medical procedures (Gordon and Schwabe 2004). Even more,
in the early eras a king was not only a secular but also a spiritual leader, possibly
involved in magical healing procedures and believed to possess healing powers
(David 1998).
Can we imagine one of the early Egyptian rulers,Aha, to be personally interested in medicine and anatomy? Inspired by his official duties as “magical
healer,” by witnessing physicians treating his warriors and livestock, or by observations of animal anatomy during ritual sacrifices, perhaps he became a kingphysician. Or maybe, appreciating the importance of the healing arts, he gathered skilled physicians at his court and ordered their knowledge to be written
down—thus becoming associated with medicine in Egyptians’ memory. Perhaps
it was not the king, but a wise healer at his court, one who was later forgotten
and whose achievements were afterwards ascribed to Aha. Or was it all just a
hoax, created centuries later?
Unless archaeologists find new proofs, we cannot be sure if Aha or Athothis
was a healer or not. Nevertheless, it seems that the possibility of such a kingphysician existed in early dynastic Egypt.Therefore, at least symbolically, we may
think of Aha as the earliest known practitioner of the medical art. The art that
blossomed when the first civilizations were born, that from its very beginning
was based both on practical healing attempts and on a study of living creatures—
the art, that was truly worthy of kings.
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